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HL7 Around the World

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Michael van Campen
Affiliate Director, HL7 Board of Directors and Chair, HL7 Canada
(2/11/10, Workshop 2, 9.30)

Published in: Health & Medicine
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HL7 Around the World

  1. 1. HL7 Around the World<br />Michael van Campen<br />HL7 New Zealand Conference, November 2, 2010<br />
  2. 2. Michael van Campen<br />Has been involved in the HL7 organization for 15+ years (internationally and in Canada)<br />Affiliate Director on the HL7 Board of Directors<br />HL7 Canada Chair<br />Involved in many HL7 activities in Canada and abroad<br />Most importantly...<br />Opinions expressed today are solely my own<br />They may be shared by others...<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />2<br />
  3. 3. Outline<br />Standards Development & the Role of the Affiliate<br />HL7 – Pulse of the Nation<br />Current Challenges<br />Moving Forward<br />Wrap up / Q&A<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />3<br />
  4. 4. Standards Development & the Role of the Affiliate<br /><ul><li>Standards 101
  5. 5. Affiliate Role</li></ul>Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />4<br />
  6. 6. Definition(s) (for consideration)<br />Health Informatics Standard<br />“An agreed upon rule or format applied to support the definition, exchange and use of data related to any aspect of Health care Information Technology (HIT) activity” *<br />* eHealth Ontario, http://www.ehealthontario.on.ca/programs/eHealthStandards.asp<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />5<br />
  7. 7. FunctionalInteroperability<br />(the conversation)<br />Semantic Interoperability<br />(the data)<br />Definition(s) (for consideration)<br />Interoperability<br />“Ability of two or more systems or components to exchange information and to use the information that has been exchanged” *<br />* IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, IEEE, 1990<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />6<br />
  8. 8. Why this Need?<br />BEFORE: Point-to-Point Interfaces<br />Pharmacy<br />Admission<br />Finance<br />PublicHealth<br />Diagnostic<br />Imaging<br />Lab<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />7<br />
  9. 9. Why this Need?<br />AFTER: Reusable HL7 interfaces (interface engines)<br />Lab<br />Pharmacy<br />Admission<br />Finance<br />HL7<br />Public Health<br />Diagnostic<br />Imaging<br />Many more approaches exist, but this illustrates how HL7 can reduce the number of interfaces, as well as standardize them!<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />8<br />
  10. 10. Standards Stepping Stones<br />Build up from a strongFoundation<br />Capabilities<br />Msgs/Svcs/Docs<br />E.g. Rx Order, Lab Result, Claim<br />Infostructure<br />E.g. Data Types, CMETs, Archetypes<br />Structures<br />E.g. Name, Address, Identifier<br />Terminology<br />E.g. Diagnosis codes, Gender, Address Type<br />Data<br />E.g. Referral Date, Prescription Number, Claim Number, Patient Name<br />
  11. 11. Standards – How did we get here?<br />Health informatics standards have been evolving for 25+ years<br />The absence of “any” standards helped form organizations such as HL7 in 1987<br />Today, standards are developed by many “competing” organizations, sometimes at cross purposes<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />10<br />
  12. 12. Standards Development Landscape<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />11<br />
  13. 13. The Standards Development Continuum<br />How far up the chain does one go?<br />Benefits are realized as you move from left to right… case in point (next slide)<br />Local<br />National<br />Multi-Nation<br />SDO<br />X-SDO<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />12<br />
  14. 14. Reaping the Benefits – Case Study (1/2)<br />Local<br />1998: The province of BC was developing an eClaims standard for Chiropractic and Physiotherapy claims<br />National<br />2000: Confirmed that a national information architecture was needed for “all” claims, such as pharmacy, medical, vision, oral health<br />Discovered the requirement for real-time adjudication<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />13<br />
  15. 15. Reaping the Benefits – Case Study (2/2)<br />SDO<br />2003: HL7 balloting and engagement confirmed information architecture and baseline requirements<br />2004: Discovered requirement for fee schedule references in Australia (Health Insurance Commission)<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />14<br />
  16. 16. Role of the Affiliate<br />Localize international standards for use in their Affiliate<br />Contribute towards the development of international standards<br />Coordinateactivitiesof the Affiliate<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />15<br />
  17. 17. Standards Work – It’s not easy!!<br />High Pain Threshold <br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />16<br />
  18. 18. HL7 – Pulse of the Nation<br />Current Challenges<br />Moving Forward<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />17<br />
  19. 19. Current Challenges<br />v2 / v3<br />Memorandum of Understanding (MOUs)<br />Imbalance in Representation<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />18<br />
  20. 20. HL7 v2.x<br />HL7 v2.x allowed HL7 to be seen as a strong Standards Organization<br />There really was no one else playing the game<br />HL7 v2.x solved many of the quick-hit interoperability problems, but still lacked<br />Consistent information model(s)<br />International focus<br />Strong methodology<br />Tooling, more than MS Word<br />Non-institutional perspectives<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />19<br />
  21. 21. HL7 v3 – A True Leadership Move<br />HL7 introduced the game changer in health interoperability in HL7 v3<br />Reference Information Model<br />Methodology<br />Strong(er) terminology bindings<br />Contemporary tooling and methods<br />HL7 was seen to be at the forefront of interoperability technology <br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />20<br />
  22. 22. HL7 v3 – The Holy Grail?<br />HL7 v3 promised:<br />Tighter specifications<br />Consistent definitions<br />Rich semantic meaning to information<br />Strong terminology binding<br />Strong tooling<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />21<br />Grade: A+<br />
  23. 23. V3 Normative Specifications - Growing<br />22<br />
  24. 24. HL7 v3 – The Execution<br />But suffered from:<br />Incomplete and inconsistently applied models<br />Poor translation / transition from HL7 v2 to v3<br />“true” support from the organization<br />Tooling woes<br />Lack of market penetration<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />23<br />Grade: C+<br />
  25. 25. HL7 v3 – The Factor<br />The rollout of HL7 v3 caused the HL7 organization to lose focus on factors outside of the organization<br />Not everyone bought in, for various reasons<br />Those that had bought in covered up any of the growing pains<br />Traction was (is) slow<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />24<br />
  26. 26. Current Challenges<br />v2 / v3<br />Memorandum of Understanding (MOUs)<br />Imbalance in Representation<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />25<br />
  27. 27. Protecting Our Turf – the MOU Game<br />MOU – Memorandum of Understanding<br />Provides a mechanism to stake out one’s territory <br />Specifies behaviours<br />Helps to ensure no one encroaches on your turf<br />Case in point – X12 and Claims<br />HL7 can include claims functionality, but not in the US<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />26<br />
  28. 28. MOUs in Play <br />HL7 currently has the following MOUs or Associate Charter Agreements:<br />ADA, AHIP, ANSI, ASC-X12, ASTM, CDISC, CEN/TC 251, CHCF, Continua, DICOM, eHI, GS1, IEEE, IHE, IHTSDO,MedBiquitous, NCPDP, NAACR, The Health Story Project<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />27<br />
  29. 29. MOUs – The Factor<br />Memorandum of Understanding – the easy answer<br />Provided absolutely little or no opportunity to resolve, harmonize or consolidate efforts<br />No clear alignment of common interests<br />Entrench the Status Quo<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />28<br />
  30. 30. Current Challenges<br />v2 / v3<br />Memorandum of Understanding (MOUs)<br />Imbalance in Representation<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />29<br />
  31. 31. HL7 International<br />35 Affiliates – who’s missing?<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />30<br />
  32. 32. Strong US Focus<br />Strong US presence at HL7 International<br />This is a good thing and a bad thing<br />HL7 is perceived (in some circles) as a US organization with international participation<br />Not an International Organization<br />Affiliate model <br />Shows international “flavour” in HL7, but fails to address<br />How the US can develop realm materials<br />Preponderance of influence (from a country perspective)<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />31<br />
  33. 33. Affiliate Model<br />Today, there is an imbalance in the organization across the US and the Affiliates<br />Membership <br />Balloting<br />Governance<br />Finances<br />Let’s not forget strong vs. weak Affiliates<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />32<br />
  34. 34. Current Challenges - RECAP<br />v2 / v3<br />Memorandum of Understanding (MOUs)<br />Imbalance in Representation<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />33<br />
  35. 35. HL7 in the Past 10 Years<br />Losing Sight of the Prize, resulting from<br />HL7 v2 & v3 dichotomy<br />Focus on MOUs and turf protection<br />US interests vs. International interests<br />In other words, content with the status quo or minor incremental change<br />We lost our edge...<br />What happened???<br />Who was watching the chicken coop???<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />34<br />
  36. 36. New Kids on the Block<br />IHE <br />Covering the compliance space, a logical extension to HL7<br />IHTSDO <br />Strong terminology models, which need to be tightly tied with information models<br />Now perceived as a true international SDO<br />OpenEHR<br />Archetypes as useful information structures<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />35<br />
  37. 37. Standards Fragmentation<br />Standards development is fragmented<br />“I need to attend how many meetings?”<br />“and where?”<br />A non-sustainable model, not only for HL7, but for all healthcare Standards development<br />Spend more time reconciling and attending meetings than doing work!<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />36<br />
  38. 38. Moving Forward<br />v2 / v3<br />Memorandum of Understanding (MOUs)<br />Imbalance in Representation<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />37<br />
  39. 39. Moving Forward on Challenge 1: v2 / v3<br />Develop comprehensive Product Strategy<br />Understand needs of stakeholders<br />Local, national and international in focus<br />Include <br />Documents constructs such as the Clinical Document Architecture (CDA) <br />Service Aware Interoperability Framework (SAIF)<br />This is under development by the HL7 Board<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />38<br />
  40. 40. Moving Forward on Challenge 2: MOUs<br />Mergers & Acquisitions <br />Looking back, a better approach (in hindsight) to MOUs might have been a Mergers & Acquisitions approach<br />SDO consolidation<br />Winners and losers<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />39<br />
  41. 41. A Success Story – Canada <br />Multiple SDO constituencies in Canada<br />Fragmented standards groups<br />Under the Infoway Standards Collaborative (SC) banner, all SDOs participate<br />ISO, HL7, IHTSDO<br />Others to be added as needed <br />Starting to see this in other countries<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />40<br />
  42. 42. SC Governance<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />41<br />
  43. 43. Moving Forward on Challenge 3a: HL7 Int’l<br />Make HL7 International, eh <br />One Member One Vote (OMOV)<br />Initiated by Charlie McKay and Rene Spronk in 2007<br />Committee struck to address membership inequality<br />Met over a number of years / WGMs, resulting in 4 concrete steps and the characteristics of an International Organization...<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />42<br />
  44. 44. OMOV Changes<br />Remove cap of 8 votes for larger Affiliates<br /># votes determined as 10% of Affiliate membership<br />Development of a Global Membership Directory<br />Will allow for further advancements of OMOV in the future<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />43<br />
  45. 45. Principals of an International Organization<br />Strong global perspectives and outreach<br />Products have clear global value<br />Ability to meet needs of both national and global requirements<br />Consistency in membership <br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />44<br />
  46. 46. Towards Internationalization<br />Commit to establishing one regional office, likely in the EU as a pilot<br />Refer to the organization as HL7 International<br />Change the name of the Affiliate Council to International Council<br />The US will define a process through which a representative from the US will participate on the International Council<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />45<br />
  47. 47. What’s Next?<br />OMOV disbanded at September 2009 HL7 WGM in Atlanta<br />New Internationalization Task Force <br />Scope is broader than OMOV<br />Looking at all aspects of HL7 from an International perspective<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />46<br />
  48. 48. Moving Forward on Challenge 3b: JIC<br />Joint Initiative Council (JIC) on SDO Global Health Informatics Standardization<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />47<br />
  49. 49. Joint Initiative Highlights<br />First Meeting, Brisbane, Aug/07<br />Initial [Process] Highlights<br />SDO work program inventory<br />First draft JWG processes<br />Initial joint projects<br />SDO joint issues addressed<br />13606 ballot, Ballot synchronizing, Comment disposition, Revisions, Templates<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />48<br />
  50. 50. Joint Initiative – The Content <br />Data Types (Grahame Grieve)<br />Pharmacovigilance and Identification of Medicinal Products <br />13606 / HL7 V3 Implementation Guide<br />BRIDG Domain Analysis Model for Protocol Driven Biomedical Research<br />Clinical Trials Registration and Results<br />Glossary<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />49<br />
  51. 51. Wrap Up & Q&A<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />50<br />
  52. 52. Our Convergence Journey…<br />Past<br />Many standards<br />HL7 v3, MOUs, US focus<br />Present<br />JIC<br />Future<br />SDO Consolidation?<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />51<br />
  53. 53. HL7 is the Right Answer<br />HL7 attracts experts from every discipline<br />HL7 Standards are world-class<br />HL7 is International in most respects and global in reach<br />Culture is supportive of new perspectives<br />Tooling initiatives promise more stability<br />HL7 constantly re-invents itself with new process, product and learnings<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />52<br />
  54. 54. Summary<br />Get our house in order<br />HL7 Internationalization<br />Support the Joint Initiative<br />Forget the MOU<br />Conquer or be Conquered<br />M&A<br />Lastly…<br />You can help! Get involved!<br />Nov 2, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />53<br />
  55. 55. March 3, 2010<br />© 2010, Gordon Point Informatics Ltd.<br />54<br />Thanks!<br />Michael van Campen<br />Gordon Point Informatics Ltd.<br />Michael.vancampen@gpinformatics.com<br />gpi<br />

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